Individual
DORA A GAXIOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
FLORIDA DEPARTMENT OF CORRECTIONS, DADE C I, 19000 SE 377TH ST, FLORIDA CITY, FL 33034
(786) 349-2364
Mailing address
10527 NW 8TH ST, PEMBROKE PINES, FL 33026
(305) 562-8809
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
17667
PR
208D00000X
General Practice Physician
Primary
ACN380
FL
261QP2400X
Prison Health Clinic/Center
ACN380
FL
Other
Enumeration date
08/20/2009
Last updated
06/05/2022
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